1023414349 NPI number — CHARTER HOSPICE OF SAN DIEGO, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023414349 NPI number — CHARTER HOSPICE OF SAN DIEGO, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARTER HOSPICE OF SAN DIEGO, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023414349
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16955 VIA DEL CAMPO STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92127-1719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-414-9717
Provider Business Mailing Address Fax Number:
760-414-9095

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
840 TOWNSITE DR
Provider Second Line Business Practice Location Address:
STE. 856
Provider Business Practice Location Address City Name:
VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92084-5566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-414-9717
Provider Business Practice Location Address Fax Number:
760-414-9095
Provider Enumeration Date:
11/13/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BOAL
Authorized Official First Name:
SYLVIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CORPORATE COUNSEL
Authorized Official Telephone Number:
909-644-4965

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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